Tourette Syndrome: Three different diseases in North America, France, and Japan
Howard I. KUSHNER
San Diego State University, History of medicine, 5500 Campanile Drive, San Diego, CA 92120-8147, USA
Tel. 619-5946258, Fax. 619-5947976
Gilles de la Tourette syndrome (TS) is a disorder in which the afflicted display an array of sudden, rapid, recurrent, nonrhythmic, and stereotyped motor and vocal tics, including, sometimes, but not always, involuntarily shouting out of obscenities. This paper examines why TS, one of the fastest growing diagnoses in North America, is almost never diagnosed by French or Japanese clinicians.
In France, where the behavior was first identified in 1885, the medical community is unified in its belief that there is no such thing as Tourette syndrome, although allowance is made for an extremely rarely occurring "Gilles de la Tourette's disease", whose etiology is seen within a psychoanalytic framework.
In Japan, where cultural customs mitigate against close observation of strangers, ticcing behaviors most often go unnoticed and present less a social barrier than in North America. In addition, children with florid tics and vocalizations are often kept from public view. As a result most pediatricians in Japan have never heard of TS, even though recent Japanese epidemiological studies indicate a prevalence similar to that in North America and Europe.
As a result of these differences, those presented with involuntary tics and vocalizations receive very different medical treatments in each society. In North America and most of Europe, where TS is viewed as in a neuropsychiatric context, pharmacology is the most frequent intervention. In France psychoanalytic psychotherapy remains dominant. In Japan, TS symptoms, when recognized, are often understood as a variation of chorea and treated with antibiotics and neuroleptics.
Panel 4B (Classification)
Wednesday, 15 September 1999
The Neurosciences and Psychiatry: Crossing the Boundaries
Joint Congress of theEuropean Association for the History of Psychiatry (EAHP), the European Club for the History of Neurology (ECHN), and the International Society for the History of the Neurosciences (ISHN)
Zurich and Lausanne, Switzerland, 13-18 September 1999